Learned Helplessness, Learned Hopelessness

While earning my undergraduate degree in psychology (about two decades ago, so kindly forgive if you have studied more recently and disagree with some of my recollections), I was introduced to the term of “learned helplessness.” At the time, it was presented as an animal model of depression.

Fortunately, we merely read about the phenomenon, rather than having to recreate it in our own labs. Whereas we trained our lab rats to press levers whenever they wanted a drink of water or a bit of food (they got very good at it), facilities elsewhere had trained animals to perform certain behaviors to prevent bad things from happening to them, like electric shocks.

Learned helplessness was the name given to how the animals behaved when their ability to avert the shocks was taken away, but intermittent pain still happened to them.

After some initial signs of distress and efforts to find some means of escape, the animals visibly hunkered down and just got used to enduring it. Even after removal from the shock-environment, they showed ongoing signs of altered behavior (diminished appetite, subdued social interaction, etc.), much of which resembled depression in humans.

At least one experiment established that you didn’t need to give the animals a means of escaping the shock to avoid inducing helplessness/depression. Giving them some kind of warning that a shock was about to occur (an audible tone, for instance) enabled them to at least predict and brace for it, rather than having the pain occur without rhyme or reason. Animals with such forewarning fared better than those without.

One of my professors distinguished this type of traumatization from the former, calling it “learned hopelessness,” rather than learned helplessness. As in humans, one is better able to weather unfavorable circumstances if one is able to make sense of how and when they might occur, even if one cannot do anything about them.

These concepts have more than a little relevance to denizens of the health care — and particularly the radiological — arenas of recent years. Most of us have never had meaningful control of the workload that comes to us. Aside from briefly during contract negotiation, we have no control over how much we get paid for our services. And even then, we’re really confined to what the government chooses to declare our work is worth. We don’t have much influence over the requirements we face for certification, licensure, and credentialing.

Like a lab rat in a cage without a lever to press, we might not have minded our circumstances at one time. But then someone started administering shocks to us, such as annual reimbursement cuts, or recurrent threats of same. At first, we had a few options: work longer hours, try to increase efficiencies in our habits, and read more studies each day. This could only offset so many adverse changes before we had no more wiggle room.

We might have flailed about, looking for anything else we could do, written a stream of letters to our legislators. Made donations to whichever political parties we thought would be kinder to us. Even warned our non-medical friends and family what we saw happening. But eventually, the shocks came anyway, with increasing frequency and intensity.

Some might have found comfort in paying careful attention to the news, listening attentively for any scraps of information that would clue them in to shocks before they arrived. Whether they were able to predict the incoming bad news and it helped them avoid learned hopelessness, only they could tell you.

We do have one option that our unfortunate lab animal friends did not. Unlike them, we are not locked in a cage. For us, the shocks are not inescapable. The moment we decide that there’s more pain than gain in this game, and choose to stop playing, we can leave.